CHAPTER 1 Cardiovascular System^55
- Install a pacemaker.
- If atrial fibrillation is the ongoing rhythm, warfarin therapy will be initiated
to reduce the risk of emboli.
NURSING DIAGNOSES
- Impaired gas exchange
- Decreased cardiac output
- Ineffective tissue perfusion
NURSING INTERVENTION
- Monitor for signs of decreased blood flow to tissues or organs (hypoperfusion)
because decreased cardiac output, as indicated by these symptoms, can occur
as a result of atrial fibrillation:- Decreased pulse pressure.
- Cool extremities.
- Altered mental state.
- Rapid resting heart rate.
- Alternating breathing between deep and shallow.
- Increased BUN.
- Prepare for synchronized cardioversion, if patient is unstable.
- Assess for life-threatening arrhythmias.
- Assess for signs of drug toxicity and withhold if the patient is toxic—i.e.,
seizures, respiratory arrest, arrhythmias. - Limit patient’s activities to reduce cardiac workload.
- Explain to the patient:
- The need for warfarin therapy, as well as monitoring of INR, diet modifi-
cations, use of NSAIDs, and aspirin. - The importance of regular examinations to ascertain for any changes in
rhythm. - Call the physician if the patient feels light-headed or dizzy, as this can be
a symptom of a change in rhythm. - Avoid ethanol, caffeine, nicotine as they can trigger an arrhythmia.
- The need for warfarin therapy, as well as monitoring of INR, diet modifi-